Sex determination relies on the translation of chromosomal sex established at fertilisation into gonadal sex (testis or ovary), and later into somatic sex (male or female) under the control of gonadal hormone secretions. The aim of the current review will be to highlight our knowledge of the key events which, in the presence of a Y chromosome, induce the organisation of the developing epithelial cells located inside the genital ridges into testicular cords. Many groups have tried to define the molecules relevant to this process, with a double goal: unravelling a molecular pathway which leads to cell fate decision (Sertoli cell in this particular case) during development; improving the establishment of a diagnosis and subsequent medical management in cases where chromosomal, gonadal and then somatic sexes are discordant. Recent progress made in this area will be depicted, with the introduction of several pieces to this developmental jigsaw puzzle.
Proximal tubal desobstuction by selective salpingography: through a study of eight cases, the authors give their first results about tubal desobstruction by selective salpingography. (C) 1999 Editions scientifiques et medicales Elsevier SAS.
Object : we attempt to determine the usefulness of uterine re-assessment by hysteroscopy in women with two unsuccessful IVF-ET attempts. Material and method, this retrospective study concerns seventy-three infertile women who have had a repeat uterine hysteroscopy after two implantation failures in IVF: Results, in half the cases, an abnormality was diagnosed. Cervical abnormalities (synechia, polyp, false passage) and hormono-dependant abnormalities (polyp, hyperplasia, submucous myoma) were the most frequent findings, The rate of pregnant women raises to twenty-two percent after treatment of these abnormalities. Conclusion, regarding our experience, if seems legitimate to perform hysteroscopy in women who have had two IVF-ET failures before attempting a third procedure.
Objective - The authors want to appraise the management of diabetes prior to pregnancy in a local population treated in the Lille University Hospital. Method - This is a retrospective study of 143 pregnancies occurring in 111 patients with diabetes prior to pregnancy, between 1987 and 1997, in the Obstetrics Department at the Lille University Hospital. Results - Only one-third of the patients benefited from preconception management; the stability of diabetes during the first trimester was satisfactory in 50% of the cases. The maternal complications are represented by preeclampsia (20%), metabolic complications specific to diabetes (hypoglycemia, ketoacidosis), the aggravation or the emergence of a retinopathy (10%) and polyhydramnios (19%). Concerning the termination of the pregnancies, of the 147 fetuses (four twin pregnancies), 140 newborns in good health, two neonatal deaths, three in-utero deaths and two therapeutic terminations of pregnancy were observed. The fetal malformation rate was 9.5% (14 cases/147). The cesarean section rate was 63%, whereas the fetal macrosomatia rate was 35%, with dystocia in 26% of the deliveries (outside of planned cesareans). Three shoulder dystocia were observed (two requiring the Jacquemier's maneuver and one with transitory plexus brachial palsy for a newborn weighing 5,650 g). Conclusion - The authors conclude that preconception management (one-third of the patients in this series) and management during the first trimester of pregnancy (50% in this series) was insufficient. This fact is perhaps due to the confusion, for many practicioners, with gestational diabetes, which is a very mediatized affection, though much less severe for the fetus and mother. (C) 1999 Editions scientifiques et medicales Elsevier SAS.
